Healthcare Provider Details

I. General information

NPI: 1194121079
Provider Name (Legal Business Name): PUTNAM COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 8TH AVE
TERRE HAUTE IN
47804-4064
US

IV. Provider business mailing address

PO BOX 221648
LOUISVILLE KY
40252-1648
US

V. Phone/Fax

Practice location:
  • Phone: 812-234-7111
  • Fax:
Mailing address:
  • Phone: 502-412-5847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DENNIS WEATHERFORD
Title or Position: PRESIDENT & CEO
Credential:
Phone: 765-655-2620